Fighting for Better Medicaid Drug Coverage

August 20, 2013

The S.L.E. Lupus Foundation once again joined many other patient groups in the "I Am Essential" coalition to submit this letter urging the Secretary of Health and Human Services to revise the final rule on prescription coverage for the expanded Medicaid program.

The plans must cover the 10 Essential Health Benefits described in the Affordable Care Act. However, the final rule from the Centers for Medicare and Medicaid Services (CMS) limits drug coverage by requiring plans to cover only the greater of one drug per class or the same number of drugs as contained in each class of drugs in the state selected benchmark plan. Historically, Medicaid beneficiaries have been able to access all drugs manufactured by companies participating in the drug rebate program. The final rule is a departure from the proposed rule and will provide beneficiaries in the expanded Medicaid program with a limited number of drugs, potentially putting their health at risk. The letter requests reconsideration of this rule and close monitoring for the expanded Medicaid program.